Depression Flashcards
major unipolar depression is one of the most common mood disorders, characterized by ______ mood (absence of happiness), _____, ____ and desperation, loss of ___, _____, _____, appetite, and _____, difficulty in ____ and ____ ____.
unhappy, worthlessness, guilt, interest, energy, motivation, pleasure, concentration, restless agitation
depressive episodes that are triggered by external events
reactive
when depressive episodes occur without apparent cause
endogenous
depression is considered pathological when symptoms are ____ or _____. There is high comorbidity of depression with other medical conditions such as ___ and ____ _____. Symptom clusters vary with individuals and there may be depression ______ associated with distinct causes and pathophysiologies
prolonged, disproportionate, anxiety, alcohol dependence, subtypes
Depression increases risk of suicide by ____%
7-15
Unipolar depression typically alternates with ____ states, and episodes last up to _____ months. Episodes can recur through life, often increasing in ____ and _____. Sometimes, depressive episodes can end on their own.
normal, 6-9, frequency, intensity
______% of the population is affected by depression. ____ are more likely to be diagnosed and incidence often coincides with major ____ changes such as post partum and ____. The incidence of depression has ____ over the last 50 years, and the age of onset has ______. Some types of depression may have a ____ influence, while others less so
15-20, women, hormonal, menopause, increased, decreased, genetic
Depression is viewed as a _____ disorder, and is closely related with anxiety. Intense stress and anxiety often ____ depression.
stress-linked, precede
Some forms of depression may be linked to alterations in the _______ and higher _____ and ____ levels.
HPA-axis, cortisol, CRF
a stress related peptide transmitter in the brain that affects numerous limbic brain regions and stimulates cortisol release
CRF
People with ____ ____, which is associated with high levels of glucocorticoids, are more prone to depression
cushing’s syndrome
Circulating levels of ____ tend to be higher in depressed subjects vs other disorders and controls.
CORT
a synthetic glucocorticoid that can suppress cortisol release in normal people
dexamethasone
Dexamethasone can “fool” the HPA axis into believing there are ____ levels of cortisol than normal. Through ____ ____, levels of cortisol drop in healthy control, but not in depressed patients. This is called the _____ _____ ____
higher, negative feedback, dexamethasone suppression test
functional imaging studies show increased blood flow / ____ utilization by the ___ and ______. Increased amygdala activity is associated with ____ that may contribute to stress / depressive symptoms. Some aspects of depression may be caused by disrupted regulation of amygdala ___ _____ by the PFC. It may be one mechanism underlying aberrant negative ____ of life events
O2, amygdala, vmPFC, anxiety, emotional processing, appraisals
Alterations in brain activity can be normalized with ______ treatment. These regions receive dense _____ and _____ input.
antidepressant, noradrenergic, serotonergic
Reduced ____ volumes have also been observed in those with depression
hippocampal
model of depression that focuses on the stress-related neuro-endocrine abnormalities of depression
glucocorticoid hypothesis
Hypothalamic CRF neurons are regulated by other nuclei: the amygdala ____ it, while the _____ inhibits it. Early life stress can increase CRF expression in the ______, increase amygdala _____ to stress, and decrease ______ ____ in the hippocampus
stimulates, hippocampus, hypothalamus, sensitivity, glucocorticoid receptors
Glucocorticoids increase hippocampal ______, and high, _____ levels of intense stress can cause _____ of hippocampal and ____ neurons.
excitability, prolonged, atrophy, PFC
impaired hippocampal function leads to the loss of _____ regulation of the HPA axis. It may also contribute to the behavioural syndrome in depression where patients often report being unable to ____ a time when they were happy. Antidepressant drugs reduce ____ levels and reverse loss of hippocampal _______ in animal studies
inhibitory, remember, CRF, dendrites
Many animal depression models involve repeated, _____ stressors.
uncontrollable
when rodents are exposed to different types of stressors such as cold temperatures, wet bedding, restraint, and sudden loud noise over 1-3 weeks to they cannot habituate to one form of stress
chronic mild stress
when an intruder rat or mouse fights a more dominant conspecific - repeated experiences with defeat can induce depression
chronic social defeat
when young animals are separated from their mothers for brief periods daily during the first few weeks of life
early maternal separation
Forced swim tests in rats or tail-suspension tests in mice model behavioural ______, as ____ is thought to reflect a ____ coping strategy. Acute antidepressant treatment reduces immobility and increases active coping strategies such as ____ and ____ in normal animals
despair, immobility, passive, swimming, climbing
typically used with the social defeat model, where rodents avoid conspecifics after repeated defeats
social avoidance
a behavioural test for depression that models anhedonia - depression reduces preference for sucrose solution vs water; chronic antidepressants can reverse this effect
sucrose preference
Behavioural tests are routinely used as screens for ____ antidepressants. However, they do not totally translate to ___ observed in human patients. For example, depressed patients still ____ sweet foods if it is presented in front of them, but are less likely to work to obtain them
novel, deficits, like
Early life stressors can make the HPA axis ______ and increase risk for depression in adult animals. Adults rats subjected to early life trauma showed higher stress-induced ____ and ____ release as adults, and greater ____ behaviours. Antidepressant treatment prevents this increase in adults and _____ the behaviours. When treatment was terminated, all the abnormalities _____
over-responsive, CRF, cortisol, depressive-like, prevents, returned
in the 1950s-60s, _____ a drug that reduces monoamine levels, was found to induce depression. The first ___ _____ _______, which block metabolism of monoamines and increase brain levels, _____ depression. The first tricyclic antidepressant ______, which blocks monoamine reuptake was also found to be effective. In the 1980s, _____ (SSRI) was found to be effective at treating depression. All of these findings support the ______ hypothesis
reserpine, monoamine oxidase inhibitors, alleviate, imipramine, fluoxetine, monoamine
the hypothesis that depression is the rsult of abnormal reduction in brain monoamine (mostly 5-HT and NE) levels
monoamine hypothesis of depression
Some limitations of the monoamine hypothesis are that antidepressants increase monoamine levels ____ yet there is a long lag between the drug treatment and the ____ of symptoms. Thus therapeutic effects may be mediated by longer lasting changes in ___/____ activity and their effects on _____ targets induced by repeated antidepressant treatment (rather than acute increases in NT release). Additionally, not all depressed patients ____ to drugs that increase monoamine levels. antidepressants tend to improve symptoms vs a placebo in more ______ depressed patients, but otherwise there is a large ____ effect. Additionally, depletion of ______ or ____ does not cause a depressive ____ in animal models. These animals instead show some behaviours that may loosely be related to depression such as _____, ______, hypersensitivity to ____ and altered patterns of ____ and ____.
quickly, alleviation, NE, 5-HT, postsynaptic, respond, severely, placebo, NE, 5-HT, phenotype, irritability, aggression, pain, feeding sleep
another limitation of the monoamine hypothesis is that _____ ______ induces symptoms of depression in unmedicated depressed patients in ____, or healthy subjects with a ____ ___ of depression, but not in healthy subjects without that history. This means merely having low levels of serotonin does not cause depression, except in ____ individuals
tryptophan depletion, remission, family history, vulnerable
Although the monoamine hypothesis is overly simple, ___ continues to be a focus because of its influence on ____ ____, _____, and response to _____ and _____ events.
5-HT, pain sensitivity, emotionality, positive, negative
suicide victims and depressed patients show lower _____ _____ and ____ levels taken from post-mortem brains or _____ /______, which is indicative of lower 5-HT activity.
5-HT metabolite, precursor, blood, CSF
polymorphisms in the _____ gene (short and long) can contribute to depression. The ____ allele is associated with reduced _____ function and ____ levels of 5-HT. These higher levels may reduce firing of 5-HT neurons via _______ inhibition. This may be linked to some forms of depression brought on by ______. Mutant mice _____ for the SERT gene (ie. only having ___ copy of the gene that reduces expression), have lower _____ 5-HT neuron firing rate.
SERT, short, transporter, higher, autoreceptor-mediated, stress, heterozygous, 1, raphe
_____ depressed individuals show increases in postsynaptic _____ receptors, which may be compensatory to ____ 5-HT activity. Chronic antidepressant treatment ______ the same receptors, in animal and human studies
unmedicated, 5-HT2, low, down-regulates
In ____ studies, the magnitude of a biological response to 5-HT _____ or ____ is measured. Depressed patients show reduced _____ to 5-HT agonists, and this can be reversed with chronic ______ treatment.
challenge, agonist, antagonist, sensitivity, antidepressant
acute SSRI treatment increases 5-HT by blocking ____. This in turn, activates ______ _____ to slow cell firing and reduces 5-HT release. Long-term SSRI treatment ______ autoreceptors, so these drugs can increase ______ 5-HT release. For example, ______ _____ autoreceptors become less sensitive to activation following chronic _____ treatment. Repeated SSRI treatment can also increase sensitivity of certain postsynaptic 5-HT receptors in the ____ and _____
reuptake, somatodendritic autoreceptors, down-regulates, synaptic, somatodendritic 5-HT1A fluoxetine, PFC, hippocampus
NE plays a key role in ____ function, reward ______, _____/_____, and the ____ response. Results of NE _____ and _____ studies of depressed patients show have been inconsistent. One consistent finding is that untreated depressed patients show increased _____ receptors which may attenuate NE release
neuroendocrine, mechanisms, attention, arousal, stress, metabolite, receptor, alpha-2
Chronic (_____ day) antidepressant treatment in animals downregulates postsynaptic ____ receptors and _____ _______. This lag parallels the onset of the ______ _______. However, this downregulation is not always seen in treated patients
7-21, beta, alpha autoreceptors, therapeutic response
There are anatomic and functional interactions between NE neurons in the ____ and the 5-HT neurons in the _____, such that drugs that affect one system can affect the other.
LC, raphe
There is renewed interest in how DA ______ may contribute to depression symptoms, particularly ______ (reduced motivation). _____ ______ ____ are being developed with consideration to not be habit forming like _____
dysfunction, anergia, triple-monoamine uptake blockers, cocaine
double-blind, placebo controlled trials show that no one drug is more ____ than any other. There is also no way to ____ how a patient will respond to a particular drug. Each patient typically undergoes ____ to find a drug that optimally balances therapeutic vs ____ ___. All drugs require _____ administration and clinical effects depend on _____ changes that takes time to develop
effective, predict, trials, side effects, chronic, neural
_____/ ____ therapy can be just as effective as antidepressants, although it takes longer, and when used in combination with drugs is even more effective
cognitive, behavioural
certain drugs, primarily _____, are associated with increased risk of ____ in children and adolescents, but the causal relationship is unclear,
SSRIs, suicide
first class of drugs used to treat depression; increases the amount of transmitter available for release within hours, but antidepressant effects require weeks of treatment
MAO inhibitors
examples of MAO inhibitors include _____ (Nardil) _____, (marplan) and _____ (parnate). The use of MAO inhibitors are now limited due to multiple side effects such as _____ disturbances, ___ gain, increase in ____ ___, interaction with other _____ medications, and naturally occurring _____, which can augment NE release and cause dangerous increase in BP. MAO inhibitors also target other _____ ____ that metabolize other drugs
phenelzine, isocarboxazid, tranylcypromine, sleep, weight, blood pressure, cold, tyramine, liver enzymes
antidepressants that block presynaptic transporters to inhibit reuptake of monoamines, which prolongs the duration of transmitter action at the synapse
tricyclic antidepressants
Different tricyclic antidepressants have different _____ and ____ reuptake blocking properties. Examples are ____, ____ and _____. Side effects of TCAs include the blocking of ___ receptors, which causes ____ and fatigue, its _____ effects, which causes ___ ___, constipation, urine retention, ____, ____, impaired ____, and ___ ____. Some TCAs also block _____ _____ receptors, and when combined with NE reuptake blocking, may lead to potentially dangerous _____ effects such as ___, ____ and _____. Overdose can cause _____ and ____ depression, _____, convulsions, ____ ___ and coma. TCAs also have a low ____ _____, meaning fatalities occur at approximately ___x the normal therapeutic dose.
NE, 5-HT, amitriptyline, desipramine, imipramine, histamine, sedation, anticholinergic, dry mouth, dizziness, confusion, memory, blurred vision, alpha-1 adrenergic, cardiovascular, tachycardia, hypotension, arrhythmia, cardiovascular, respiratory, delirium, cardiac arrest, therapeutic index, 10
2nd generation antidepressants that are most commonly prescribed, as the side effect profile is typically better than 1st generation drugs
SSRIs
The therapeutic effect of SSRIs is mediated by increased activation of some 5-HT receptors. Activation of other receptors can lead to _____, _____ disorders, _____, ____ and ____ dysfunction.
anxiety, movement, insomnia, headaches, sexual
dangerous effects when SSRIs combined with other 5-HT agonists or drugs that interfere with SSRI metabolism
serotonin syndrome
serotonin syndrome can lead to ____, ____, _____, ____, fever, ____, diarrhea, increased ___ ____ and ______ ______.
agitation, disorientation, ataxia, spasms, shivering, heart rate, blood pressure
SSRIs can cause physical ______ and ____ that can last several weeks. This results in ____, ____ vivid ____, increased ____, ____ and _____
dependence, withdrawal, fatigue, insomnia, dreams, anxiety, agitation, irritability
ketamine is a _____ _____ antagonist. At ______ doses through _____, there is rapid reduction in depressive symptoms for _____% of treatment ______ patients (after psychosis dissipates). Effects last for _____ weeks, and an _____ formula has recently been approved.
non-competitive, NMDA, sub-anaesthetic, IV, 7, resistent, 1-3, intra-nasal
The mechanism of ketamine appears to be driven by increased ______. It can potentiate ____ receptor function, potentially by increasing ____ and _____ release in the PFC. Administration of ____ ____ ____ prevents the antidepressant response to ketamine in animal models. Ketamine also induces multiple forms of ___ ___ via activation of multiple ___ ___ with effects persisting after acute effects have worn off. Ketamine ____ may also contribute to antidepressant effects
excitation, AMPA, glutamate, DA, AMPA receptor antagonists, synaptic plasticity, signalling cascades, metabolites
characterized by periods of depression alternating with mania
bipolar disorder
symptoms of mania include inflated __ _____, reduced need for ____, flight of ____, ______, increased ____ ___ activity, but rarely completed tasks. When mania subsides, difficulties related to behaviour due to mania can trigger bouts of ______.
self esteem, sleep, ideas, distractibility, goal directed, depression
the cycling ____ of bipolar disorder varies, but rapid cycling consists of ___ or more cycles in one year. Some may cycle several times in one _____. Mania rarely occurs _____.
rate, 4, day, alone
a milder form of bipolar disorder in which patients cycle between dysthymia (milder depression) and hypomania (increased energy)
cyclothymia
incidence of mania is considerably ____ than depression. There is a _______% higher prevalence in the U.S. and men and women are affected _____
lower, 1-4, equally
The neural basis of mania is poorly understood, but may involve pathology of the ____ and ____
hippocampus, amygdala
the most effective medication for patients with bipolar disorder
lithium carbonate
lithium carbonate eliminates / reduces ____ episodes without causing depression or producing _____. it has no effect in ____ individuals. It takes ___ weeks for maximal effects to emerge and is particularly effective in reducing ____ in bipolar individuals. Lithium elevates brain _____ _____ levels, and increases _____ ____. At the same time, it reduces ______ activity by enhancing _____ and reducing ____. Lithium likely modifies _____ ___ at points beyond the transmitter receptors (ie. second messenger systems).
manic, sedation, healthy, 2-3, suicide, tryptophan 5-HT, 5-HT release, catecholamine, reuptake, release, synaptic transmission
the side effects of lithium are generally mild but include increased ___, ____, impaired ___ and ____, fatigue, ____ and ____ gain. Higher levels can be ____ and occur when plasma ____ levels are lower. The ____ ___ is low and thus blood levels of lithium must be ____ regularly.
thirst, urination, concentration memory, tremor, weight, toxic, Na+, therapeutic index, monitored
